Home Health & Hospice Week

A durable medical equipment item is the top issue in Region C under RAC Connolly Inc., so don't be surprised if other home care topics start making it onto RACs' hit lists.

CMS lists "DMEPOS provided during an Inpatient stay: (DMEPOS Automated Review)" as the top Region C issue in its newly issued summary report for the RACs' third quarter. "Medicare does not make separate payment for DMEPOS when a beneficiary is in a covered inpatient stay," CMS notes in the report. The other three regions have hospital topics listed as their top issues.

RACs collected $233.4 million in overpayments during the quarter and returned $55.9 million in underpayments, CMS says in the report at www.cms.gov/Recovery-Audit-Program/Downloads/FFSUpdate.pdf. Region D RAC HealthData Insights collected more than twice as much as any other RAC at $112.2 million.

Meanwhile, if you do end up with an overpayment demand from a RAC, you won't actually hear from the contractor directly. RACs will no longer send out demand letters, but CMS has simply transferred the responsibility of that task to processing contractors.

"When a recovery auditor finds that improper payments have been made to you, they will submit claim adjustments to your Medicare (claims processing) contractor," CMS says in new MLN Matters article MM7436. "The Medicare contractor will follow the same process as is used to recover any other overpayment from you."

Once you get word from your MAC that it is seeking RAC monies, you'll stay in touch with the MAC regarding any issues about timeframes and appeals. However, if you have audit-specific questions "such as the rationale for identifying the potential improper payment," you'll contact the RAC personally, CMS notes.

The article is at www.cms.gov/MLNMattersArticles/Downloads/MM7436.pdf.